EP2254564A1 - Combinations comprising 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline - Google Patents

Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
  • A61K31/4525—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a five-membered ring with oxygen as a ring hetero atom
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
  • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
  • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present application relates to new uses of 5-HT 6 receptor antagonists, specifically 3- phenylsulfonyl-8-piperazinyl-1yl-quinoline, and to the combination of 5-HT 6 receptor antagonists, specifically 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline, with a second therapeutic agent.
• WO03/080580 discloses compounds of formula (I) and pharmaceutically acceptable salts thereof:
• R 1 and R 2 independently represent hydrogen or Ci -6 alkyl or R 1 is linked to R 2 to form a group (CHz) 2 , (CH 2 ) 3 or (CH 2 ) 4 ;
• R 3 , R 4 and R 5 independently represent hydrogen, halogen, cyano, -CF 3 , -CF 3 O, Ci -6 alkyl, Ci -6 alkoxy, Ci -6 alkanoyl or a group -CONR 6 R 7 ;
• R 6 and R 7 independently represent hydrogen or Ci -6 alkyl or together may be fused to form a 5- to 7- membered aromatic or non-aromatic heterocyclic ring optionally interrupted by an O or S atom; m represents an integer from 1 to 4, such that when m is an integer greater than 1 , two R 2 groups may instead be linked to form a group CH 2 , (CH 2 ) 2 or (CH 2 ) 3 ; n represents an integer from 1 to 3; p represents 1 or 2; A represents a group -Ar 1 or - Ar 2 Ar 3 ;
• Ar 1 , Ar 2 and Ar 3 independently represent an aryl group or a heteroaryl group, both of which may be optionally substituted by one or more (eg. 1 , 2 or 3) substituents which may be the same or different, and which are selected from the group consisting of halogen, hydroxy, cyano, nitro, trifluoromethyl, trifluoromethoxy, Ci -6 alkyl, trifluoromethanesulfonyloxy, pentafluoroethyl, Ci -6 alkoxy, arylCi -6 alkoxy, Ci -6 alkylthio, Ci -6 alkoxyCi -6 alkyl, C 3-7 cycloalkylCi -6 alkoxy, Ci -6 alkanoyl, Ci -6 alkoxycarbonyl, Ci -6 alkylsulfonyl, Ci -6 alkylsulfinyl, Ci -6 alkylsulfonyloxy, Ci -6 alkylsulf
• 3-Phenylsulfonyl-8-piperazinyl-1yl-quinoline can be prepared as described in WO03/080580 or by the further process described in WO07/039238.
• WO05/040124 discloses a further polymorphic form of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline as Form III.
• Parkinsons Disease ADHD (Attention Deficit Disorder/Hyperactivity Syndrome), sleep disorders (including disturbances of Circadian rhythm), feeding disorders such as anorexia and bulimia, panic attacks, withdrawal from drug abuse such as cocaine, ethanol, nicotine and benzodiazepines, schizophrenia (in particular cognitive deficits of schizophrenia), stroke and also disorders associated with spinal trauma and/or head injury such as hydrocephalus.
• WO03/080580 also discloses that Compounds of formula (I) and their pharmaceutically acceptable salts are expected to be of use in the treatment of certain Gl (gastrointestinal) disorders such as IBS (Irritable Bowel Syndrome) and in the treatment of obesity.
• cognitive memory disorders includes other neurodegenerative disorders associated with dementia, e.g. VaD (Vascular Dementia), DLB (dementia with Lewy Bodies), Mixed AD+CVD (Alzheimer's Disease and Cardiovascular Disease) and HD (Huntingdon's Disease).
• VaD Vascular Dementia
• DLB disementia with Lewy Bodies
• Mixed AD+CVD Alzheimer's Disease and Cardiovascular Disease
• HD Hauntingdon's Disease
• US2007/0167431 and WO07/087151 disclose a method for the treatment of a cognitive disorder such as Alzheimer's disease in a patient in need thereof which comprises providing to said patient a therapeutically effective amount of a combination of an acetylcholinesterase inhibitor and a 5-HT 6 receptor antagonist.
• US2007/0167431 discloses that the acetylcholinesterase inhibitors suitable for use are donepezil (i.e. AriceptTM manufactured by Pfizer), galanthamine (i.e. Razadyne TM, manufactured by Johnson and Johnson), rivastigmine (i.e. ExelonTM, manufactured by Novartis) or any other compounds known to inhibit acetylcholinesterase.
• 5-HT6 antagonists suitable for use. Furthermore the following 5HT6 compounds were listed by name, 3-(1- naphthylsulfonyl)-5-piperazin-1yl-1 H-indazole, N,N-dimethyl-3- ⁇ 3-(1-naphthylsulphonyl)- 1 H-indazol-5-yl]oxy ⁇ propan-1 -amine, (2- ⁇ [3-(1-naphthylsulphonyl)-1 H-indazol-7- yl]oxy ⁇ ethyl)amine, 1-(phenylsulphonyl)-4-(1-piperazinyl)-1 H-indazole, 5-chloro-N-[4- methoxy-3-(1-piperazinyl)phenyl]-3-methylbenzo(b)thiophene-2-sulfonamide (SB- 271046), 4-amino-N-[2,6-
• the present invention provides the combination of a 5-HT 6 receptor antagonist, specifically 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof, with a second therapeutic agent.
• a therapeutic agent known to modify cholinergic transmission such as M1 muscarinic receptor agonists or allosteric modulators, M2 muscarinic antagonists, acetylcholinesterase inhibitors, nicotinic receptor agonists or allosteric modulators, 5-HT4 receptor partial agonists or 5HT1 A receptor antagonists and NMDA receptor antagonists or modulators, glutamate antagonists, GABA-ergic antagonists, H3 antagonists, putative metabolic/mitochondrial modulators, or disease modifying agents such as ⁇ or ⁇ -secretase inhibitors, Tau- targeted therapeutics,
• Examples of putative metabolic/mitochondrial modulators are KetasynTM, RSG-XR, intranasal insulin and Dimebon.
• ⁇ -amyloid aggregation inhibitors and ⁇ -amyloid immunotherapies examples include PBT2 (Prana Biotechnology), ELND005/AZD-103 (Elan and Transition Therapeutics), Gammagard/IGIV (Baxter International), monoclonal antibody LY2062430 (EIi Lilly), and bapineuzumab (Wyeth/Elan).
• Tau-targeted therapeutics include tetramethylthionine chloride (REMBERTM, TauRX) and AL-108 (Allon).
• This combination may be useful in the treatment of cognitive memory disorders, for example Alzheimer's disease, age related cognitive decline and mild cognitive impairment, neurodegenerative disorders for example dementia including vascular dementia (VaD), dementia with Lewy Bodies (DLB), Alzheimer's Disease and Cardiovascular Disease (Mixed AD+CVD) and Huntingdon's Disease (HD).
• dementia including vascular dementia (VaD), dementia with Lewy Bodies (DLB), Alzheimer's Disease and Cardiovascular Disease (Mixed AD+CVD) and Huntingdon's Disease (HD).
• VaD vascular dementia
• DLB dementia with Lewy Bodies
• AD+CVD Alzheimer's Disease and Cardiovascular Disease
• HD Huntingdon's Disease
• the present invention also provides a method for the treatment of cognitive memory disorders, for example Alzheimer's disease, age related cognitive decline and mild cognitive impairment, neurodegenerative disorders for example dementia including vascular dementia (VaD), dementia with Lewy Bodies (DLB), Alzheimer's Disease and Cardiovascular Disease (Mixed AD+CVD) and Huntingdon's Disease (HD) in a patient in need thereof which comprises providing to said patient a therapeutically effective 5 amount of a combination of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof, with a therapeutic agent known to modify cholinergic transmission such as M1 muscarinic receptor agonists or allosteric modulators, M2 muscarinic antagonists, acetylcholinesterase inhibitors, nicotinic receptor agonists or allosteric modulators, 5-HT4 receptor partial agonists or 5HT1 A 10 receptor antagonists and NMDA receptor antagonists or modulators, glutamate antagonists, G
• One embodiment is directed to combinations of 3-phenylsulfonyl-8-piperazinyl-1yl- quinoline or a pharmaceutically acceptable salt thereof and a second therapeutic agent selected from donepezil, rivastigmine, tetrahydroaminoacridine, memantine, galantamine, 6-[(3-cyclobutyl-2,3,4,5-tetrahydro-1 H-3-benzazepin-7-yl)oxy]- ⁇ /-methyl-3- pyridinecarboxamide hydrochloride or 1- ⁇ 6-[(3-cyclobutyl-2,3,4,5-tetrahydro-1 H-3-
• the present invention provides a combination of 3- T t- phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof with an antidepressant, for example a tricyclic, a MAOI (Monoamine oxidase inhibitor) a SSRI (Selective Serotonin Reuptake Inhibitor), a SNRI (Serotonin and Noradrenaline Reuptake Inhibitor) or a NaSSA (noradrenergeric and specific serotonergic antidepressant).
• an antidepressant for example a tricyclic, a MAOI (Monoamine oxidase inhibitor) a SSRI (Selective Serotonin Reuptake Inhibitor), a SNRI (Serotonin and Noradrenaline Reuptake Inhibitor) or a NaSSA (noradrenergeric and specific serotonergic antidepressant).
• the present invention provides a combination of 3- phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof and an atypical antipsychotic, for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden.
• an atypical antipsychotic for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden.
• the present invention provides a method for the treatment of schizophrenia in a patient in need thereof which comprises providing to said patient a therapeutically effective amount of a combination of 3-phenylsulfonyl-8-piperazinyl-1yl- quinoline or a pharmaceutically acceptable salt thereof, with an atypical antipsychotic, for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden.
• an atypical antipsychotic for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden.
• the present invention provides a combination of 3- phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof and a second therapeutic agent suitable for use in Attention Deficit Disorders/Hyperactivity Syndrome, e.g. methylphenidate (Ritalin) or dexamfetamine (Dexedrine).
• a second therapeutic agent suitable for use in Attention Deficit Disorders/Hyperactivity Syndrome e.g. methylphenidate (Ritalin) or dexamfetamine (Dexedrine.
• the present invention also provides the use of a combination of 3- phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof and a second therapeutic agent in the manufacture of a medicament for use in the treatment of the above disorders.
• the present invention provides the use of a combination of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof with a therapeutic agent known to modify cholinergic transmission such as M1 muscarinic receptor agonists or allosteric modulators, M2 muscarinic antagonists, acetylcholinesterase inhibitors, nicotinic receptor agonists or allosteric modulators, 5- HT4 receptor partial agonists or 5HT1 A receptor antagonists and NMDA receptor antagonists or modulators, glutamate antagonists, GABA-ergic antagonists, H3 antagonists, putative metabolic/mitochondrial modulators, or disease modifying agents such as ⁇ or ⁇ -secretase inhibitors, Tau-targeted therapeutics, ⁇ -amyloid aggregation inhibitors and ⁇ -amyloid immunotherapies, in the manufacture of a medicament for use in the treatment of cognitive memory disorders, for example Alzheimer's disease
• the present invention provides the use of a combination of 3- phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof and an atypical antipsychotic, for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden in the manufacture of a medicament for use in the treatment of schizophrenia.
• an atypical antipsychotic for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden
• the present invention is also directed to new uses of 3-phenylsulfonyl-8-piperazinyl-1yl- quinoline or a pharmaceutically acceptable salt thereof; specifically
• a) further psychiatric disorders with prominent cognitive deficits e.g. chronic PTSD (Post traumatic stress disorder); b) non-degenerative disorders with prominent cognitive deficits: MS (multiple Sclerosis), post-chemotherapy, post-CABG (Coronary artery bypass graft), post-stroke; and c) paediatric disorders: autism, mental retardation and learning disabilities.
• PTSD Post traumatic stress disorder
• MS multiple Sclerosis
• CABG Coronary artery bypass graft
• post-stroke post-stroke
• paediatric disorders autism, mental retardation and learning disabilities.
• the invention further provides a method of treatment or prophylaxis of these disorders, in mammals including humans, which comprises administering to the sufferer a therapeutically effective amount of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof.
• the invention also provides the use of a 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for use in the treatment or prophylaxis of these disorders.
• the invention also provides combinations of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline and a second therapeutic agent for use in these disorders.
• the second therapeutic agent may be selected from: serotonergic antidepressants (SSRIs), e.g. fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), trazodone (Desyrel); medicines that help decrease the physical symptoms associated with PTSD, e.g.
• SSRIs serotonergic antidepressants
• fluoxetine Prozac
• sertraline Zac
• Zoloft paroxetine
• Paxil paroxetine
• trazodone Desyrel
• medicines that help decrease the physical symptoms associated with PTSD e.g.
• clonidine Catapres
• guaneficine Teenex
• propranolol mood stabilizers
• mood stabilizers such as lamotrigine (Lamictal), tiagabine (Gabitril), divalproex sodium (Depakote); monoamine oxadazine inhibitors, phenelzine (Nardil); antiadrenergic agents, e.g. clonidine (Catapres), propanolol (Inderal) and guanfacine (Tenex), mood stabilizers that are also antipsychotics, like risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel).
• the second therapeutic agent may be selected from: steroids, e.g. methylprednisolone (eg Depo- Med rone), prednisone, dexamethasone disease-modifying agents e.g. interferon beta-1 a (Avonex or Rebif), interferon beta-1 b (Betaferon), glatiramer acetate (Copaxone) injections or mitoxantrone (Novantrone); symptomatic agents e.g.
• steroids e.g. methylprednisolone (eg Depo- Med rone), prednisone
• dexamethasone disease-modifying agents e.g. interferon beta-1 a (Avonex or Rebif), interferon beta-1 b (Betaferon), glatiramer acetate (Copaxone) injections or mitoxantrone (Novantrone); symptomatic agents e.g.
• Muscle Relaxants (Baclofen, Dantrolene, Tizanidine, Cyclobenzaprine, Clonazepam, Diazepam); Anticholinergics (Propantheline, Tolterodine Dicyclomine); Urinary Tract Antispasmodics (Oxybutynin); Tricyclic Antidepressants (Amitriptyline, Imipramine); Antidiuretic Hormone (desmopressin and desmopressin acetate); Anticonvulsants (carbamazepine, phenytoin, acetazolamide, lamotrigine); Central Nervous System Stimulants (pemoline); Selective Serotonin Reuptake Inhibitors (SSRIs) (citalopram, fluoxetine, paroxetine, sertraline); Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) (ibuprofen, naproxen, ketoprofen); and Phosphodiesterase-5 Inhibitors (sildenafil
• the second therapeutic agent for use in the treatment of MS or its associated symptoms may be selected from an H3 receptor antagonist, 6-[(3-cyclobutyl- 2,3,4,5-tetrahydro-1 H-3-benzazepin-7-yl)oxy]- ⁇ /-methyl-3-pyridinecarboxamide hydrochloride or 1- ⁇ 6-[(3-cyclobutyl-2,3,4,5-tetrahydro-1 H-3-benzazepin-7-yl)oxy]-3- pyridinyl ⁇ -2-pyrrolidinone; S1 P1 agonists; anti-CD20 monoclonal antibody therapies such as rituximab, ofatumumab; anti-CD3 monoclonal antibody therapies such as otelixizumab; rosiglitazone (AvandiaTM), alpha 4 integrin antagonist e.g firategrast, natalizumab (TYSABRITM).
• H3 receptor antagonist 6-[(3-cyclobutyl- 2,3,4,5-
• the second therapeutic agent for use in the treatment of MS or its associated symptoms may be selected from BG12 (Biogen pout), an S1 P agonist e.g. Fingolimod, an immunosuppressant e.g. Laquinimod, Teriflunomide; an estrogen agonist e.g. Trimesta.
• S1 P agonist e.g. Fingolimod
• an immunosuppressant e.g. Laquinimod, Teriflunomide
• an estrogen agonist e.g. Trimesta.
• the second therapeutic agent may be selected from: Aldesleukin or IL-2 (Proleukin), Alemtuzumab (MabCampath), Amsacrine (acridinyl anisidide; m-AMSA), Anastrozole (Arimidex), Asparaginase (Crisantaspase), Bevacizumab (Avastin), Bicalutamide (Casodex), Bleomycin, Bortezomib (Velcade), Busulfan, (Campto) Irinotecan, Capecitabine (Xeloda)
• Carboplatin (Paraplatin), Carmustine (BCNU), Cetuximab, Chlorambucil, Cisplatin, Cladribine (2-CdA, Leustatin), Co-codamol, Cyclophosphamide, Cyproterone acetate (Cyprostat), Cytarabine (Ara C, cytosine arabinoside), dacarbazine (DTIC), Dactinomycin (Actinomycin D), Daunorubicin, Disodium pamidronate (Aredia), Docetaxel (Taxotere), Doxorubicin, Epirubicin, Erlotinib (Tarceva), Estramustine (Emcyt, Estracyte), Etoposide (VP16, Etopophos), Exemestane (Aromasin), Fentanyl (Durogesic), Fludarabine, Fluorouracil (5FU), Flutamide (Drogenil), Gemcitabine (Ge
• the second therapeutic agent may be lapatinib, which may also be used in conjunction with capecitabine.
• the second therapeutic agent may be selected from alteplase (Actilyse), aspirin, dipyridamole, fluvastatin sodium (Lescol), clopidogrel hydrogen sulphate (Plavix), ramipril (Tritace) and simvastatin (Simvador, Zocor).
• the two therapeutic agents may be administered simultaneously or sequentially and, when administration is sequential, either may be administered first. When administration is simultaneous, the combination may be administered either in the same or different pharmaceutical composition.
• the two therapeutic agents may be used either as separate formulations or as a single combined formulation. When combined in the same formulation it will be appreciated that the two compounds must be stable and compatible with each other and the other components of the formulation.
• the present invention also provides pharmaceutical compositions comprising an effective amount of a combination of a 5-HT 6 receptor antagonist, specifically 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline or a pharmaceutically acceptable salt thereof and a second therapeutic agent, and a pharmaceutically acceptable carrier.
• the second therapeutic agent is an agent known to modify cholinergic transmission such as M1 muscarinic receptor agonists or allosteric modulators, M2 muscarinic antagonists, acetylcholinesterase inhibitors, nicotinic receptor agonists or allosteric modulators, 5-HT4 receptor partial agonists or 5HT1 A receptor antagonists and NMDA receptor antagonists or modulators, glutamate antagonists GABA-ergic antagonists, H3 antagonists or disease modifying agents such as ⁇ or ⁇ -secretase inhibitors.
• the second therapeutic agent is an antidepressant, for example a tricyclic, a MAOI (Monoamine oxidase inhibitor) a SSRI (Selective Serotonin Reuptake Inhibitor), a SNRI (Serotonin and Noradrenaline Reuptake Inhibitor) or a NaSSA (noradrenergeric and specific serotonergic antidepressant).
• a MAOI Monoamine oxidase inhibitor
• SSRI Selective Serotonin Reuptake Inhibitor
• SNRI Serotonin and Noradrenaline Reuptake Inhibitor
• NaSSA noradrenergeric and specific serotonergic antidepressant
• the second therapeutic agent is an atypical antipsychotic, for example olanzapine, clozapine, prisperidone, quentiapine, aripriprazole or paliperiden.
• the second therapeutic agent is a therapeutic agent suitable for use in Attention Deficit Disorders/Hyperactivity Syndrome, e.g. methylphenidate (Ritalin) or dexamfetamine (Dexedrine).
• a therapeutic agent suitable for use in Attention Deficit Disorders/Hyperactivity Syndrome e.g. methylphenidate (Ritalin) or dexamfetamine (Dexedrine).
• a pharmaceutical composition may be prepared by admixture, suitably at ambient temperature and atmospheric pressure, and is usually adapted for oral, parenteral or rectal administration and, as such, may be in the form of tablets, capsules, oral liquid preparations, powders, granules, lozenges, reconstitutable powders, injectable or infusable solutions or suspensions or suppositories. Orally administrable compositions are generally preferred.
• Tablets and capsules for oral administration may be in unit dose form, and may contain conventional excipients, such as binding agents, fillers, tabletting lubricants, disintegrants and acceptable wetting agents.
• the tablets may be coated according to methods well known in normal pharmaceutical practice.
• Oral liquid preparations may be in the form of, for example, aqueous or oily suspension, solutions, emulsions, syrups or elixirs, or may be in the form of a dry product for reconstitution with water or other suitable vehicle before use.
• Such liquid preparations may contain conventional additives such as suspending agents, emulsifying agents, non-aqueous vehicles (which may include edible oils), preservatives, and, if desired, conventional flavourings or colourants.
• fluid unit dosage forms are prepared utilising a compound and a sterile vehicle.
• the compound depending on the vehicle and concentration used, can be either suspended or dissolved in the vehicle.
• the compound can be dissolved for injection and filter sterilised before filling into a suitable vial or ampoule and sealing.
• adjuvants such as a local anaesthetic, preservatives and buffering agents are dissolved in the vehicle.
• the composition can be frozen after filling into the vial and the water removed under vacuum.
• Parenteral suspensions are prepared in substantially the same manner, except that the compound is suspended in the vehicle instead of being dissolved, and sterilization cannot be accomplished by filtration.
• the compound can be sterilised by exposure to ethylene oxide before suspension in a sterile vehicle.
• a surfactant or wetting agent is included in the composition to facilitate uniform distribution of the compound.
• composition may contain from 0.1 % to 99% by weight, preferably from 10 to 60% by weight, of the active material, depending on the method of administration.
• compositions may, if desired, be presented in a pack or dispenser device which may contain one or more unit dosage forms containing the active ingredients.
• the pack may, for example, comprise metal or plastic foil, such as a blister pack. Where the compounds are intended for administration as two separate compositions these may be presented, for example, in the form of a twin pack.
• compositions may also be prescribed to the patient in "patient packs" containing the whole course of treatment in a single package, usually a blister pack.
• Patient packs have an advantage over traditional prescriptions, where a pharmacists divides a patients supply of a pharmaceutical from a bulk supply, in that the patient always has access to the package insert contained in the patient pack, normally missing in traditional prescriptions.
• the inclusion of a package insert has been shown to improve patient compliance with the physicians instructions. It will be understood that the administration of the combination by means of a single patient pack, or patient packs of each composition, including a package insert directing the patient to the correct use of the combination is a desirable additional embodiment.
• a patient pack comprising at least one active ingredient, of the combination and an information insert containing directions on the use of the combination.
• a double pack comprising in association for separate administration of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline and the second therapeutic agent.
• suitable unit doses may be 0.05 to 1000 mg, more suitably 0.05 to 200 mg, for example 20 to 40 mg; and such unit doses will preferably be administered once a day, although administration more than once a day may be required; and such therapy may extend for a number of weeks or months.
• the dose of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline used in combination with a second therapeutic agent may be same as when it is used on its own or may be different. It may be possible that the dose of either drug used may be lower when used in combination than when used separately.
• Suitable behavioural models of cognition known to the person of ordinary skill in the art, for example object recognition memory in young Sprague-Dawley and aged Fisher rats, Water Maze model to investigate spatial learning and memory in young and aged Fisher rats.
• a suitable animal model for studing multiple sclerosis is the experimental autoimmunal encephalomyelitis (EAE) model.
• the study may be performed as a multicenter, double-blind, placebo controlled randomised, parallel group determination of efficacy of 3-phenylsulfonyl-8-piperazinyl- 1yl-quinoline in combination with an atypical antipsychotic agent approved for the treatment of schizophrenia vs an atypical antipsychotic agent approved for the treatment of schizophrenia with placebo.
• the study may be performed using a therapeutic dose within the prescribed guidelines of Risperidone.
• the patients may receive an appropriate dose of the atypical antipsychotic agent (defined antipsychotic agent or antipsychotic) ,and, depending on which group they belonged, a therapeutically effective amount 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline once daily or placebo over 12 weeks after a brief wash-out period of earlier antipsychotic medication.
• a benzodiazepine preparation mostly lorazepam
• Patients with agitation, anxiety, or sleeping problems may be also medicated with lorazepam during the study.
• biperiden may be monitored as a possible indicator for side effects of the antipsychotic medication.
• the plasma levels of this drug may be monitored during the study.
• the statistics may be performed according to the criterion of "last observation carried forward” (LOCF), i. e., the last PANSS scores of the patients who dropped out before the end of the study were carried forward to all subsequent observation days.
• LOCF last observation carried forward
• t-tests for independent samples may be employed.
• a significance of p ⁇ 0.05 may be calculated in the one-tailed t-test and used as the basis for the estimation of the sample size (statistical power) and for the comparison of the groups.
• two-tailed t-tests may be used.
• the combination of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline and an atypical antipsychotic agent according to the present invention thus may show improved results compared to the monopreparation of the atypical antipsychotic agent with regard to effectiveness in the treatment of schizophrenia.
• Rat social interaction after chronic treatment with SSRI/TCA ( File, 1980 J. Neurosci Methods, 2:219-238; Lightowler et al., 1994, Pharmacol., Biochem.
• a double-blind multicenter clinical trial may be designed to assess the safety and efficacy of 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline of the present invention in combination with an SSRI such as paroxetine for treatment of Bipolar Disorder, Bipolar Depression or Unipolar Depression.
• Patients are randomized to 3-phenylsulfonyl-8- piperazinyl-1yl-quinoline, an SSRI such as paroxetine or 3-phenylsulfonyl-8-piperazinyl- 1yl-quinoline plus an SSRI.
• an 8-week, double blind trial, 28 patients diagnosed with treatment- resistant major depression would be randomized to one of three treatment arms: (1 ) paroxetine and placebo; (2) 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline and placebo; or (3) paroxetine plus 3-phenylsulfonyl-8-piperazinyl-1yl-quinoline.
• the efficacy of the treatment may be monitored using the HAMD-21 (Hamilton M. Journal of Neurology, Neurosurgery & Psychiatry. 1960.23: 56-62, and Hamilton M. Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology.

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• 2008
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